The spectrum of pathological conditions affecting the nasopharynx includes infections, congenital anomalies, and tumoral lesions, particularly angiofibroma, nasopharyngeal carcinoma, and lymphoma. Hypertrophy of adenoid tissue is a frequent phenomenon in children, but it is less common in the adult population. With this case report, we wanted to point out the importance of rhinological and otological manifestations of adenoid hypertrophy in adult patients. A 48-year-old man presented with impaired hearing in both ears, difficulty breathing through the nose, impaired sense of smell, hyponasal speech, and occasional scanty bleeding from the right side of the nose. After taking detailed data, the diagnostics included a classic ENT examination, endoscopy of the nasal cavity and nasopharynx, audiological diagnostics, allergy tests, computerized tomography of the paranasal sinuses and the skull base, and serological analysis for viruses and protozoa. A soft tissue lesion that filled the entire nasopharynx was surgically removed, and the pathohistological analysis indicated B-cell small lymphocytic lymphoma (SLL) with polyclonal plasma cell differentiation. Serological analyses showed that it was a human immunodeficiency virus (HIV)-positive patient, who also had a high blood titer of IgG to the Epstein-Barr virus. The patient was admitted to another institution for oncology treatment under the supervision of an infectious disease specialist. Although rare, malignant transformation of nasopharyngeal lymphoid tissue is possible. B-cell SLL with polyclonal plasma cell differentiation represents a minority of malignancies originating from the nasopharynx, and there are limited data regarding epidemiologic and treatment outcomes. Early recognition and thorough evaluation are essential to distinguish benign enlargement from more serious conditions.
Labus et al. (Sun,) studied this question.